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Carotid endarterectomy versus stenting: Does the flow really change? An Echo-Color-Doppler analysis

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Abstract

To assess potential hemodynamic differences after carotid endarterectomy (CEA) and carotid artery stenting (CAS) and their eventual impact on clinical management. Between July 2012 and October 2013 two groups of 30 patients each referred for CEA or CAS were prospectively enrolled in two tertiary hospital care centers. Pre-procedural imaging assessment of carotid artery disease was performed with Echo-Color-Doppler (ECD) and computed tomography angiography (CTA). ECD was repeated within 24 h and 1, 6 and 12 months after surgical/endovascular procedures. Peak systolic velocity (PSV) and end diastolic velocity (EDV) were assessed at two standard sites: common carotid artery (CCA) and distal internal carotid artery (ICA). Twenty-four hours ECD findings highly differ between the two populations. CCA PSV in the CEA and CAS groups was respectively 44.88 ± 9.16 and 69.20 ± 20.04 cm/s (p = 0.002); CCA EDV was 16.11 ± 2.29 and 19.13 ± 6.42 cm/s (p = 0.065); ICA PSV was 46.11 ± 7.9 and 94.02 ± 57.7 cm/s (p = 0.0012); ICA EDV was 20.22 ± 4.33 and 30.47 ± 18.33 cm/s (p = 0.025). One month, 6 months and 1 year findings confirmed the different trend in the two cohorts; in particular, at 1 year: CCA PSV was 50.94 ± 12.44 and 60.59 ± 26.84 cm/s (p = 0.181); CCA EDV was 17.11 ± 3.46 and 19 ± 16.35 cm/s (p = 0.634); ICA PSV was 51.66 ± 10.1 and 70.86 ± 20.64 cm/s (p = 0.014); ICA EDV was 25.05 ± 8.65 and 32.66 ± 13 cm/s (p = 0.0609). ECD follow-up of patients undergone CEA or CAS may play a critical role in the clinical management. Strict surveillance of blood flow velocities allows reducing false positive re-stenosis diagnosis and choosing the best anti-aggregation therapies. Within the first month CEA patients benefit from a lower risk condition in comparison with CAS patients, due to a significantly faster PSV drop; moreover, long-term CCA PSV after CEA could be used as a surrogate marker of neointima formation.

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Authors and Affiliations

  1. Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy

    Pierleone Lucatelli, Fabrizio Fanelli & Carlo Cirelli

  2. Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy

    Beatrice Sacconi, Michele Anzidei & Carlo Catalano

  3. Department of Surgery, Section of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo di Monserrato, Cagliari, Italy

    Roberto Montisci & Roberto Sanfilippo

  4. Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo di Cagliari, Cagliari, Italy

    Elisabetta Tamponi

  5. Department of Medical Imaging, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo di Monserrato, Cagliari, Italy

    Luca Saba

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  1. Pierleone Lucatelli
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  2. Fabrizio Fanelli
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Correspondence to Pierleone Lucatelli.

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Lucatelli, P., Fanelli, F., Cirelli, C. et al. Carotid endarterectomy versus stenting: Does the flow really change? An Echo-Color-Doppler analysis. Int J Cardiovasc Imaging 31, 773–781 (2015). https://doi.org/10.1007/s10554-015-0623-0

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  • DOI: https://doi.org/10.1007/s10554-015-0623-0

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